Reducing Administrative Burden in Health Care: AHA Calls for Streamlined Prior Authorization Process in Medicare Advantage

The American Hospital Association (AHA) recently submitted a statement to the Senate Budget Committee, calling for Congress to streamline the prior authorization process in Medicare Advantage. AHA highlighted that the current prior authorization practices add significant financial burden and strain to the health care system, leading to inappropriate payment denials and increased costs for staffing and technology. The organization emphasized that these requirements are a major burden to the health care workforce and contribute to provider burnout.

Surgeon General Vivek Murthy has also issued an advisory stating that burdensome documentation requirements, including prior authorization, are contributing factors to health care worker burnout. AHA urged legislators to simplify and standardize prior authorization requirements, conduct more audits on plans with a history of inappropriate denials, establish a provider complaint process for suspected federal violations, enforce penalties for non-compliance, and clarify state oversight roles in Medicare Advantage.

In addition, AHA recommended adding prompt payment requirements for Medicare Advantage plans when services are provided by in-network providers to enrollees. Plans failing to make timely payments should be subject to interest penalties. AHA also expressed support for legislation promoting gold carding programs and endorsed CMS’s proposed rule to standardize claims attachments under HIPAA. By implementing these measures, AHA believes the administrative burden in health care can be reduced and the system can operate more efficiently.